Disease that makes winter unbearable
Dr Vikas Sharma

Contact with fresh tap water while doing normal house-hold work is enough to freeze her fingers, turning them blue and numb. “They turn purplish blue, almost like they’re stained after coming in contact with a carbon paper,” explains a young woman whose suffering continues until the end of the winter months. “Usually, my thumb, index and middle fingers on both hands are affected more than the others.”

“People make comments when they see me wearing gloves in parties what they consider to be unusual. They ask me if I am coming straight from hills and have forgotten to remove them. “I also used to wear gloves in my office and people would say, ‘Um, are you cold?’ Yes, I was.”

She suffers from Raynaud’s disease, a painful, annoying and sometimes embarrassing disorder of the blood vessels that affects an estimated 7-30 per cent of people worldwide. People with Raynaud’s are unusually super-sensitive to cold temperatures, and even the briefest exposure (like holding a cold can of soda, or taking something out of the freezer) can trigger a Raynaud’s “attack,” causing fingers or toes to feel numb as they turn a patriotic shade of either red, white or blue.

Essentially, it’s due to vasospasm, or hyperactivity of the blood vessels and it is a normal response of the body in trying to stay warm to constrict those vessels, but this is a kind of a hyper-response to that.

In other words, when people with Raynaud’s feel cold, they’re really cold. When you feel cold, your blood vessels constrict, which reduces blood flow and cuts down on heat leaving your body. But in people with Raynaud’s, the blood vessels overreact, shrinking so much that very little blood is able to flow to the fingers or toes, which is what makes them feel numb and change colour. (It’s rare, but Raynaud’s can affect the ears, the lips, the nose and even nipples.)

About 80 per cent of Raynaud’s sufferers are women. Sometimes, Raynaud’s is caused by an autoimmune disorder such as scleroderma, or by a medication, but in most people it is a primary problem while in others it is an indicator of something internal.

Female patients of Raynaud’s, with the age of onset being over 25 years, with no pre-existing intolerance to cold, no history of occupational, traumatic and medication exposure, need thorough investigation to rule out autoimmune disorders like systemic sclerosis, systemic lupus erythematosus, scleroderma, rheumatoid arthritis and dermatomyositis.

A typical attack consists of sudden pallor (white-yellow) of one or more digits, followed after a few minutes by bluishness and then redness. The condition is usually symmetrical and affects several digits. The secondary changes that can occur include visibility of dilated blood vessels on nail folds, thinning of nails, thinning and atrophy of fingers. It is of paramount importance to rule out an autoimmune collagen vascular disorder because then there is a very high possibility of involvement of other organs and in some cases development of gangrene at the localised site.

The key is simply to keep warm even when that means looking a bit silly. But patients with primary Raynaud’s often respond to conservative measures, including wearing of two layers of gloves , inner cotton and outer woolen. Avoidance of exposure to cold, wet and windy climatic conditions helps a lot.

Smoking is prohibited as it can aggravate the condition.

Even placing hands too close to heaters/blowers should be avoided especially after an attack of Raynauds’ following sudden exposure to cold.

Patients need full emotional support. Stress is an aggravating factor. Modifications in daily life and work are necessary. Occupational exposure may warrant change of Job/place. A balanced diet and avoidance of drugs like oral contraceptives, heavy metals and beta- blockers is a must.

When these measures are ineffective, the medications of choice are topical and oral vasodilators, especially calcium channel blockers.

Other diseases of abnormal sensitivity to cold include perniosis, acrocyanosis, livedo reticularis, etc.

Chilblains (Perniosis): It attacks with painful, red coloured often itchy skin lesions which may blister or ulcerate. They occur especially on fingers and toes, nose and ears. In contrast to normal individuals, in whom moderate cold exposure induces the constriction of blood vessels supplying skin over the area, which is then succeeded by vasodilatation in an attempt to maintain reperfusion, a persistent cold-induced constriction of large vessels that occurs in those individuals who are affected by chilblains.

The writer is the Chief Consultant-Dermatologist and Dermato-Laser Surgeon, National Skin Hospital, Panchkula. E-mail :  drvikas.nscindia@gmail.com

Homoeopathy can help treat eczema effectively
Dr Harsh Sharma

A common skin disorder that troubles many people is eczema. It is a general term and covers a wide presentation of skin symptoms. The equivalent medical term is dermatitis. To understand what is meant by eczema, one just needs to have a look at the dictionary meaning of the word. ‘Eczema’ is derived from the Greek language in which ‘ek’ means ‘out’ and ‘zein’ means ‘to boil’. So, eczema could mean a variety of skin disorders in which the skin seems to be boiling out or boiling over.

It is actually the inflammation of the skin and can present itself in different ways in different patients. A number of skin diseases like atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, nummular eczema and seborrheic dermatitis are categorised under the heading of eczema or dermatitis.

Those patients who have a personal or family history of allergic disorders like asthma, hay fever or dermatitis are said to have atopic dermatitis. In the atopic variety, itching is the most prominent feature. Bleeding, redness and swelling are secondary to scratching and rubbing associated with itching. That is why the atopic variety is called the ‘itch that rashes’ whereas usually in skin disorders, it is the rash that itches. This may be dry or ‘weeping’. Crusts may form because of the discharge collecting and drying on the affected surface. The common areas of involvement are the face, neck, folds of skin as of elbows, armpits and behind the knees. Children are usually most affected.

The other variety of dermatitis happens to be due to one’s contact with chemicals that can cause allergy in certain individuals while others are not at all affected by the same substances. These allergens or irritants may be present in soaps, detergents, cosmetics, jewellery or even some plants and foodstuffs. The most commonly affected areas are the exposed surfaces like hands and arms. Women and industrial workers are quite prone to such dermatitis as they are most exposed to these things. The symptoms may be of the dry, thick, red and scaly variety or the oedematous, weepy and discharging type.

Seborrheic dermatitis is another common variety that presents as oily, greasy scales over red patches. The most common location is the scalp where it is often mistaken as dandruff. It also affects eyebrows, eyelids, ears, armpits and the central chest area. Itching and burning usually accompany the visible skin symptoms.

For those who suffer from the allergic dermatitis and contact dermatitis varieties, it is important that they prevent exposure to such substances as cause these symptoms. At times, it is difficult to know the exact things that aggravate the skin condition. Under such circumstances, general precautions will have to be resorted to. Hands can be protected by wearing gloves. Other areas can be covered by suitable clothing. Those allergic to cosmetics or nickel in jewellery should switch over to other non-allergic varieties or avoid these altogether.

Role of homoeopathy

Homoeopathy has been very effective in curing this trouble. Regular treatment with the right medicines is able to completely cure the disease and there is no recurrence afterwards. Homoeopathic medicines like Sulphur, Graphites, Merc Sol and Rhus Tox have been found to be quite effective, but the proper selection of the correct remedy in each individual, a detailed history of the patient and the aggravating factors are necessary.

The writer is a Mohali-based practising homoeopath.

Ten ways to handle knee pain
Dr Ravinder Chadha

Maintaining a healthy knee joint throughout life is extremely important for any individual. This is the most commonly afflicted but most useful joint. Knee afflictions due to various causes lead to discomfort and long-term problems resulting in a handicap. The knee is the most vulnerable weight-bearing joint which can get injured due to many factors. Since prevention is better than cure, the following tips, if followed meticulously, can protect the knee effectively:

1. Maintaining body alignment: Those children who have flat feet, knock knees and bowleg stance are very prone to knee or ankle injuries, etc. Parents, if vigilant during the early years of their children, can certainly prevent these defects. These defects are sometimes common in toddlers which disappear itself by the age of seven. Early intervention (prior to the age 12) can prove beneficial. After the age of 12 when the bones unite, shoe modification with the strengthening of lower limbs can help prevent heel, ankle and knee pain.

Individuals suffering from knee arthritis experience pain on the inner side of the knee. Hence they tend to shift the weight on the outer part of the leg/foot resulting in bowleg deformity. The shoe heel on the outer side is generally worn out in such cases. Treatment in the form of heel wedge and physical activity when initiated early can prevent bowlegs and reduce discomfort/pain.

2. Walking/running surface: The choice of terrain is very important to prevent knee injuries. Flat surface that is soft and smooth is ideal. Elderly people, in whom meniscus (cushion in the knee) becomes degenerated with age, are vulnerable to injury even on experiencing a mild jerk such as walking on an uneven path.

3. Proper footwear: This is the most important yet generally neglected factor in our part of the world. Although awareness is slowly creeping in, we have a long way to go. Shoes should be able to absorb the shock of the body so as not to place the load on the ankle and knee joints. Walking or jogging with wrong or worn-out shoes completely negates the benefits of the activity. Walking shoes, though lighter than the jogging shoes, do not possess adequate cushioning. Worn-out shoes should be replaced as they are unable to absorb the shock. An individual who runs/ jogs twice or three times a week must ideally change his/her shoes after a span of six months.

4. Watching weight: Obese children are prone to knee injuries as one kg of extra weight increases six times of the load on the knees. Obese patients with a knee problem add misery to their disability. Hence weight reduction is of paramount importance in such cases.

5. Stabilising the knee: In the case of instability, knee support/brace can be used. Knee wraps available in the market sometimes do more harm than good by increasing the pressure on the knees. If these are too tight, swelling appears on the ankle. It is better to use knee support/brace when there is instability/ pain with movement. Knee brace having a hole in the centre for the patella and which can be locked from the sides are ideal.

6. Modify your aerobic activity: People suffering from knee pain avoid aerobic activities with the result that they gain weight and increase the load on their knee. A switch-over to cycling, swimming, etc, is the alternative. In cases where knee bending is possible stationary cycling is an ideal aerobic activity as it takes the load off the knees.

7. Importance of stretching /strengthening: Keeping the muscles and ligament holding the knee strong protect the knees. Weak muscles and ligaments place load on the joints, causing pain particularly while climbing up and down. The following basic exercises are advisable to protect the knee:

n Sit with your back against the wall, bend one leg and raise the straight leg six inches off the ground. Hold it for a count of eight and lower it slowly. Repeat 10 times.

n Sit on the floor with the affected leg in front. Place a rolled towel/pillow under the knee. Push the knee downward by tightening the muscles of the front of the leg. Hold for a count of 10 and then relax. Repeat 10 times.

n Lie on the stomach —- Wrap a stretch band around the ankles and bend one knee. A stretch shall be felt at the back of the thigh. Lower it and repeat it 10 times. The above basic exercises can be followed by exercises like squats, step-up, lunges and strengthening of the lower limbs.

8.Analgesic ointments increase the temperature by generating heat in the area concerned, making the patient comfortable but there is no curative effect.

9.Do not delay the treatment Immediately after injury apply ice, use compression by wrapping with a crepe bandage and raise the knee by placing pillows under ankle joint. Applying ice packs three to four times a day for two days reduces pain/inflammation. In case of acute pain, weight bearing should be avoided for a day or two.

10. Role of medicines: Unlike other countries India is flooded with analgesic and anti-inflammatory medicines. These should be used in acute cases to reduce pain and inflammation. In chronic cases, these should be used whenever there is severe pain as their prolonged use can cause side-effects like hyperacidity and pain in the abdomen.

The writer is a former doctor/physiotherapist, Indian cricket team, and runs his pain management clinic.

E-mail-chadha_r2003@yahoo.co.in